Diagnosis and Treatment Strategy of Achalasia Subtypes and Esophagogastric Junction Outflow Obstruction Based on High-Resolution Manometry.
Diagnosis and Treatment Strategy of Achalasia Subtypes and Esophagogastric Junction Outflow Obstruction Based on High-Resolution Manometry.
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基于高分辨率测压的贲门失弛缓症亚型和食管胃交界部流出道梗阻的诊断和治疗策略。
DOI：
10.1159/000452354
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Nakamura K.
中科院分区：
文献类型：
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作者：
Ihara E;Muta K;Fukaura K;Nakamura K.
研究背景根据芝加哥分类法第3.0版，食管胃连接部流出道梗阻（EGJOO）包括贲门失弛缓症（I、II、III型）和EGJOO。虽然目前没有治愈性治疗可用于治疗EGJOO的疾病，但药物治疗，内窥镜充气扩张术（PD），腹腔镜Heller肌切开术（LHM）和经口内窥镜肌切开术（POEM）通常是受欢迎的治疗模式。由于EGJOO疾病的病因和发病机制可能会有所不同，治疗策略应根据这些亚型考虑。SummaryBased on the accumulated evidence，the treatment strategies of our institution are as follows：药物治疗对贲门失弛缓症的影响是有限的。根据患者的意愿，PD或LHM/POEM均可视为I型贲门失弛缓症的一线治疗。PD和POEM可分别视为II型和III型贲门失弛缓症的一线治疗。相反，在EGJOO中，包括阿考替胺和/或地尔硫卓在内的药物治疗可以作为一线治疗进行测试，PD和POEM将分别被视为二线和三线治疗。关键信息基于高分辨率测压的亚型分类将帮助我们根据EGJOO疾病的亚型考虑哪种治疗方案可以选择作为一线治疗。Acotiamide有可能治愈EGJOO患者。
BackgroundBased on Chicago Classification version 3.0, the disorders of esophagogastric junction outflow obstruction (EGJOO) include achalasia (types I, II and III) and EGJOO. Although no curative treatments are currently available for the treatment of the disorders of EGJOO, medical treatments, endoscopic pneumatic dilation (PD), laparoscopic Heller myotomy (LHM), and per-oral endoscopic myotomy (POEM) are usually the sought-after modes of treatment. Since the etiology and pathogenesis might vary depending on the types of EGJOO disorders, treatment strategies should be considered based on those subtypes.SummaryBased on the accumulated evidences, the treatment strategies of our institution are as follows: effects of medical treatments on achalasia are limited. Either PD or LHM/POEM can be considered a first-line in achalasia type I, according to the patient's wish. PD and POEM can be considered first-line in achalasia types II and III, respectively. Conversely, In EGJOO, medical treatments including drugs like acotiamide and/or diltiazem can be tested as a first-line, and PD and POEM will be considered second and third-line treatments, respectively.Key MessagesThe classification of subtypes based on high-resolution manometry will help us consider which treatment option can be selected as a first-line treatment depending upon the subtypes of disorders of EGJOO. Acotiamide has the potential to cure patients with EGJOO.